Fig. 7

Endometrioid adenocarcinoma developed on deep pelvic endometriosis in a 58-year-old woman with a history of infertility. Sagittal (a) and axial (b) T2-weighted images show a large heterogeneous mass obliterating the Douglas cul-de-sac composed of solid (white arrows) and cystic (asterisk) portions. Axial fat-suppressed T1-weighted image shows hemorrhagic content within the cystic cavity (c). Diffusion-weighted imaging (d high b value) shows a high signal intensity within the solid portion with corresponding enhancement on axial enhanced fat-suppressed T1 image (e). Axial T2-weighted sequence at a higher level (f) shows the features of deep pelvic endometriosis of the posterior compartment (dotted arrow) and a metastatic nodule of the mesorectum (arrowhead). “Kissing ovaries” containing small-sized endometrioma (arrowheads) are seen on corresponding fat-suppressed T1-weighted image (arrowheads (g)). Restricted diffusion within the mesorectum metastasis is also seen (h)